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Friday, August 12, 2016

I spent the past week at the International Society for Augmentative and Alternative Communication Biannual Conference, held this year in Toronto, Canada. I learned a lot and enjoyed my time meeting people I had only known online before then.

By the second day of the conference I realized that I might need to repost a slightly revised version of this post from four years ago at ISAAC in Pittsburg.

At ISAAC Pittsburg I started joking that we all needed color coded dots on our name tags as shorthand to tell others which "church" of AAC we have joined.

What I mean is that people who believe dogmatically in a certain system of AAC (or device or symbols) to the exclusion of others and are such fervent believers that they appear to belong to a sect or a very demanding church. Some people needed green dot because of their belief in Visual Scene Displays while others needed a red dot because of their belief in PODD (Pragmatic Organization for Dynamic Display). Still others needed other color dots for MinSpeak/Unity, WordPower, and Bliss Symbolics. Of course there were also people who needed some identification to show that it was a specific hardware or system they followed, the PRC people (and correspondingly MinSpeak/Unity/LAMP), the Dynavox folks, etc. And then there where those who needed some kind of mark to show they followed a personality more so than anything else.

There is nothing wrong with believing strongly in any of these "churches" of thought in AAC. All these people and the people behind all of these systems are trying to do good. They believe in the power of augmentative and alternative communication.

The problem seems to come when followers of any of these believe in them so ardently that they cannot allow for the fact that there are other ways of doing things. The problem increases when we in the field push one means or method of AAC over another merely because it is what we know well, it is the church we belong to, at the exclusion of systems or supports that may be more suited to the situation at hand. Additionally, proselytizing our own churches of AAC to parents and future AAC users can give the false impression that the system, symbols or device are more important than how we implement it.

Families and future AAC users are frequently lead to believe that if we just, "get it right" with the selection of a system, device or symbols then communication will happen, like magic. This isn't true. Learning to be an efficient and functional AAC user takes years and years of instruction and hard work. Professionals bemoan families who will not use AAC systems or devices at home, but we don't spend much time looking at how our actions created this reality. We, usually without meaning to, create the idea that getting the system is the cure, then we fail to follow best practice in implementation. Truthfully, communication success with AAC depends much more on implementation than anything else, on how we teach and present AAC.

If we moved our focus from our "churches" to how we implement AAC, no matter which system, device or symbols, we would see more competent communication users and less abandoned devices.

Some suggestions:

Before anything else, in the absence of other evidence we must Presume Competence! And even in the face of what we believe to be evidence we must Presume Potential! There is no such thing as "too low to communicate". And you must have words to prove you can use words.

Here are some of the things we can all do regardless of which system we are implementing:

Create a language rich environment - label everything, with descriptive labels, not just with the symbol for the thing but also with core vocabulary, so instead of the symbol for "light switch" by the light switch but a sentence strip of "Turn light on" over the switch and "Turn light off" under the switch. Then model by pointing to each word on the label, and if possible in the communication system, EVERY time you use it. Use visual schedules. Model, model, model these adaptations ALL THE TIME.

Train all those who work with students who use AAC, including professionals outside special education and speech such as PT and OT as well as parents, siblings and peers in implementation techniques

Use more symbols not less, assuming you should "start small" seems obvious, but with only 4, 6, 8 or 10 symbols there is not much to say and little to model. Start with a larger vocabulary for best results. Visual Scene Displays may be a transitional tool in children under 18 months but we all eventually need words.

Aided Language Stimulation is a must - all those involved in implementation MUST consistently and constantly model the use of the communication system (no matter which communication system)

you can do this by using the student's device yourself and having others use it

you can do this with wall charts

you can do this with another system or device for the adult to use to model

you can do this with a printed version of a higher-tech system

you can do this with an ELMO camera placed over a low or high tech device

you can do this in so many other ways, your imagination is the only limit

using Aided Language Stimulation will slow the teacher/therapist/communication partner down, increasing time for verbal processing

think of Aided Language Stimulation as "Immersion", everyone agrees that immersion is the best way to learn a foreign language, creating an immersion environment for AAC is also the best way to learn Augmented Communication

Zip your lips and wait. Nothing is more important than quieting yourself and allowing an AAC user to listen, think, form a message and respond. I will say it again, ZIP your lips and WAIT!

Use the "expectant pause" during conversations, when it is the AAC users turn to participate, learn forward, keep your eyes kindly on the user, look ready but patient and BE QUIET.

After the message use re-castingto edit the user's message - If the child makes the message, "I good." You re-cast it by saying, "I am good." (This one comes naturally to moms and those who spend time with small children.)

Ask open ended questions to expand, "I think you are good. Why do you think you are good?"

Respond to every communication attempt - even if it is just to say you heard him or her and the answer is no.

Assume intentionality to teach intentionality. One of the worse things we can possibly do is doubt the child's communication. How many times have you heard someone say, "I don't think he meant that", right in front of the student? We must assume that all communication is purposeful for the child to learn that communication is a worthwhile endeavor.

Make sure the device or system is always available, how else will the user learn how important and valuable it is if we don't go through that trouble?

You are not the blue fairy, you do no good to anyone by magically reading an AAC users mind and providing everything they need whether they ask or not. (Yes, maybe you are his or her mother, but how would you like it if YOUR mother tried to read YOUR mind?) Learn to step back and wait for requests, if you must take action then model how to request on the user's device before you do

Have alow tech back up to high tech systems, and teach how to use that too

Beyond all else, BELIEVE! Believe in the power of AAC. Believe in your power to give the gift of communication. BELIEVE that your student or child can learn how to communicate.

Can I get an, "Amen"?

P.S. I had many, many conversations with and watched many presentation by teenagers and adults who use AAC fluently at the ISAAC Pittsburg and Toronto conferences. Some used light tech, some used Toby Churchill Lightwriters, Some used PODD, some used Tobii Dynavox, some used iPads, many used PRC devices. There is NO such thing as one size fits all in AAC.

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